santa barbara county jail intake screening process...

2015-16 Santa Barbara County Grand Jury 1

SANTA BARBARA COUNTY JAIL

Intake Screening Process

SUMMARY

The 2015-2016 Santa Barbara County Grand Jury (Jury), reviewed the inmate intake procedures of the

Santa Barbara County Jail (Jail) to ensure the facility is operating within the scope of California Code of

Regulations Title 15 (Title 15) and the Santa Barbara Sheriff’s Office (SBSO) Custody Operations Policy

and Procedures Manual. This report outlines the operations, procedures, and observations made of the

intake process, as well as findings, discrepancies, and recommendations made by the Jury.

The Jury found the intake screening process of the SBSO and Corizon Health (Corizon) was inconsistent

in following established protocols, policies, and procedures. The medical intake process is cumbersome

as the inmate medical records are not computerized. SBSO staff does not provide adequate oversight of

Corizon contracted medical staff. In at least one instance, Corizon employees failed to follow established

medical intake protocols.

According to SBSO staff, they are aware of these problems with the intake screening process and are

already taking steps to reorganize the intake process to correct the problems identified. New protocols,

policies, and procedures are being discussed by Corizon and the SBSO. In addition, a new Health

Services Administrator and a Grievance Coordinator have been hired to ensure that any protocol

deviations are addressed. As of the completion of this report, these changes are still in the

implementation process.

BACKGROUND

The Santa Barbara County Jail (Jail) is a Type II detention facility, as described by the California Code

of Regulations, Title 15 (Title 15), used for the custody of persons pending arraignment, during trial and

upon sentencing. The Jail is operated by the Santa Barbara Sheriff’s Office (SBSO). It has been

described as a revolving door with many of the same people being arrested, jailed, and released only to

be arrested again. Arrestees are transported to the Jail daily from throughout the county. The Santa

Barbara County Grand Jury (Jury) learned that approximately 75 percent of the Jail inmates are

categorized as pretrial inmates. Some may stay less than one day or until their court arraignment

proceeding and are then released. It is not uncommon for about 60 percent of the inmate population to

leave within two to four weeks. There are at least 40 to 60 arrestees a day who must go through the

intake procedure. Whether it’s a short stay or a long stay, all arrestees entering the Jail must go through

an intake process which includes a medical evaluation.

Agreement with Corizon Health Since July 1, 2013, SBSO has had a Correctional Medical Agreement with Corizon Health (Corizon), a


national for-profit correctional health care company based in Tennessee. This two year contract with the

SBSO was scheduled to expire on June 30, 2015. However, the Board of Supervisors (BOS) extended

the contract to March 31, 2017.

The SBSO contract with Corizon is intended to ensure arrestees entering the Jail receive adequate

medical evaluations and that inmates are provided appropriate medical care. Corizon staff are required

to work within the contracted budget and operational constraints of the Jail. The Jury recognizes this can

be a challenging task because many arrestees enter the Jail in poor health with preexisting medical

conditions. According to SBSO staff, approximately 75 percent of inmates in the Jail have substance

abuse issues. The Jury was told that most of the arrestees entering the Jail have one or more medical

problems. It costs approximately $60,000 a year to house an inmate in the Jail.1 The recidivism rate is

approximately 70 percent which means that seven out of ten inmates will re-offend and end up back in

the Jail and will have to go through the intake screening process again.

METHODOLOGY

Members of the Jury toured the Jail and observed the intake operation of the Jail, during regular work

hours, and reviewed a video of an intake process. The Jury reviewed the SBSO Custody Operations

Policy and Procedures Manual (Manual), staff memorandums, and reports. The Jury also examined

intake assessment forms. In addition, the Jury also interviewed SBSO custody officers and Corizon staff.

OBSERVATIONS AND ANALYSIS

The Jail provides the following core set of prisoner intake functions:

Identifying the prisoner

Developing the prisoner’s record

Conducting medical and mental health assessments.

Determining the prisoner’s threat to public safety and his/her security requirements

Identifying sex offenders, sexual predators, and vulnerable inmates

Scheduling transfers to the long-term facility

Identifying and validating security threat group membership

The intake process at the Jail operates 24 hours a day with approximately 40 to 60 arrestees arriving at

the Jail daily. Many are under the influence of drugs or alcohol, have physical injuries, or are mentally

ill. These factors make the intake process challenging for the SBSO and Corizon staff.

According to SBSO staff, the Jail is understaffed, under-funded and not well designed to carry out all of

their required responsibilities. Individuals who need significant medical attention at the time of intake

are generally not accepted in the Jail. Instead they are taken to the local hospital for medical evaluation

and stabilization. The intake screening would then be performed at the Jail when the inmate returns from

the hospital. Once an inmate is admitted to the Jail the County of Santa Barbara is responsible for the

cost of any outside medical care.

1 Jail Staffing and Operating Cost Analysis, Santa Barbara County, Final Report CGL Companies, October 2015


The Health Services Administrator (HSA), a Corizon employee, is a Registered Nurse (RN) and is

responsible for the day-to-day operations of the medical programs at the Jail. The HSA has the authority

to oversee the administrative requirements of the programs, as well as recruitment, staffing, data

gathering, financial monitoring, and enforcing policies and procedures.

Processing Procedures The inmate intake procedure is a twofold process that includes a medical evaluation and a classification

procedure that requires the cooperation of both SBSO staff and Corizon staff. The first step starts with

a “SBSO Santa Barbara Sheriff Medical Pre-Screening” questionnaire, (see Appendix A) used to

determine if there are current health issues that require prompt attention. In the past, this prescreening

was performed by custody officers. According to the contract, SBSO staff receives up to 24 hours of

training on medical issues annually by Corizon. However, this training is not adequate for SBSO staff

to make many medical decisions. Therefore, deputies are no longer doing the medical intake

prescreening on new bookings. The Jury learned that as of April 11, 2016, Corizon RNs are now

performing the entire medical intake assessments. This is intended to ensure that medical needs are being

met at intake. The medical prescreening questionnaire is an assessment tool used to determine if the

inmate is ambulatory, alert, sick, suicidal, intoxicated, on medication, or has a history of drug or alcohol

abuse. The name of the arrestee is entered into the Jail Management System (JMS), an inmate

management software package, to determine if the arrestee has a previous record. If so, and if the arrestee

has a significant medical condition such as heart problems, diabetes, drug/substance abuse history or

psychological issues that were identified and recorded, the JMS would “red flag” the inmate information

for ease of future retrieval. During the pre-screening, the detainee is asked about medication or street

drugs recently used. Depending on the types of medications the detainee claims to be using, the nurse

attempts to verify the prescribed medication by calling the detainee’s doctor, clinic, or pharmacy.

After conducting the medical prescreening using the SBSO questionnaire, the Corizon RN also evaluates

whether the arrestee has significant medical issues that need to be addressed. This second medical

evaluation uses Corizon’s “Intake and Receiving Screening form CS1101” (see Appendix B). Based on

this evaluation the RN refers any arrestee with an urgent medical need to the Corizon contracted medical

doctor (MD) for a follow up appointment. The Medical Process Overview, Medical Referral Sources,

flow chart provided by SBSO staff (see Appendix C), does not reflect the new medical intake procedure

and needs to be revised.

An arrestee who discloses a history of drug or alcohol abuse is assessed with the Clinical Opiate

Withdrawal Scales (COWS) (see Appendix D.) According to Corizon staff, if an arrestee is identified as

having a history of substance abuse, there is a “protocol” to ensure they are monitored closely. For

example, if it is determined that the arrestee is a habitual intravenous drug user, according to the Corizon

staff “the inmate is to be placed in observation and medication ordered to help reduce withdrawal

symptoms.” These procedures are not outlined in the Receiving Screening Process (see Appendix E).

These protocols are only referenced in the Manual Section 303.Use of Sobering/Observation Cell.

The Jury observed, that although SBSO and Corizon are supposed to work together, this cooperative

collaboration has not always existed. SBSO staff has not always followed established oversight

procedures to ensure Corizon staff are operating in accordance with their contract. Fundamental

responsibilities may not be completed during a work shift. With proper monitoring, problems can be

alleviated. SBSO staff does not have checklists or guidelines to reduce the risk of incomplete evaluation


by Corizon staff. The Jury recommends that the Sheriff Office update Appendices C and E. Additionally,

two signature blocks, one for medical clearance staff the other for the custody officer prior to

classification should be added to the forms in Appendices A and B.

A critically important next step, after the arrestee is medically cleared, is classification. The classification

which is conducted by SBSO Staff determines where in the jail the new inmate will be housed. During

this time the inmate is issued a wristband that includes pertinent personal information and moved to a

holding cell. Whether the inmate is a new arrestee, or a reoffender, they go through the same intake

process. For the safety of all concerned, it is imperative that this two-step process requires close

collaboration between Corizon and SBSO staff to ensure that inmates entering the Jail are medically

cleared and classified before placement in the general population.

Protocols When the Intake Screening Process is completed, information is documented in the JMS which includes

general health concerns. Also documented are external observations of behavior, appearance,

deformities, injuries, and skin lesions, which might be indicators of illicit drug use. Inmates entering the

Jail are tested for tuberculosis if they are expected to be there longer than 72-hours. In the case of a

female arrestee, gynecological and pregnancy issues are noted.

If there are any concerns noted during the medical intake process, the Corizon staff takes necessary steps

to reconcile these issues. The medical intake RN may refer the inmate/patient to the MD or Nurse

Practitioner (NP), give them needed bridge medications, or initiate other treatments or protocols. The

MD or the NP sees the patients that have been referred to them as scheduled by the intake nurse. This

procedural change is an improvement that will result in inmate/patients receiving the most appropriate

level of care whether it is urgent, emergent or routine. If the medical review is not conducted in

accordance with written procedures, and discrepancies are not corrected, situations can develop with

unforeseeable complications.

Intake Process Failure During the intake review, the Jury observed that medical records in the Jail are stored using an antiquated,

paper system. According to Corizon and SBSO staff, medical records are not computerized for quick

access and both recognize this as a serious deficiency. If further information is needed during a medical

intake, Corizon staff must manually retrieve medical records which are stored in paper form in the

medical unit. Although the JMS flags chronic medical conditions, the information is frequently limited

and insufficient to medically evaluate inmates with major medical issues. If the medical records were

stored electronically, medical intake evaluations could be conducted after first reviewing their previous

medical history in the jail.

SBSO staff have established procedures and protocols on how to process inmates. However, the Jury

found that at least in one case, the intake procedures were not followed and an inmate was released into

the general population without a completed medical screening. It is vitally important that every step of

the medical intake process be conducted for each arrestee. A deviation from the approved process may

result in an arrestee’s significant medical needs not being met when in the custody of the county, resulting

in an intake process failure and possible major liability. All medical screening forms need to be signed

and dated prior to classification. The classification by a custody officer must confirm that medical

clearance has been completed prior to placement of the inmate to the appropriate location in the Jail.


A combination of events, such as the arrestee not responsibly and accurately reporting their medical

condition, Corizon staff not completing their medical evaluation, and/or custody staff not overseeing the

Corizon process, could result in intake process failure.

The Manual, Chapter 3, Section 303 (Use of Sobering/Observation Cell), outlines procedures to be used

when an inmate is admitted to the Jail while under the influence of alcohol or other substance.

Determining the level of intoxication or drug effect is subjective. When in doubt, in order to err on the

side of safety, the use of sobering/observation cells is imperative. The consistent use of these cells

ensures that inmates who are at risk are properly monitored.

CONCLUSIONS

The 2015-16 Santa Barbara County Grand Jury (Jury) determined that there have been inconsistencies

in the intake screening process at the Santa Barbara County Main Jail (Jail). The Jury finds the medical

prescreening questionnaire is not sufficient for Santa Barbara County Sheriff Office (SBSO) staff to

determine if an arrestee has major medical concerns. SBSO staff receive minimal medical training

annually. There has been a lack of SBSO oversight of Corizon Health (Corizon) medical staff to ensure

the orderly, safe, and healthy intake of arrestees into the Jail. There has been a failure of SBSO staff to

consistently follow their own intake procedure.

According to SBSO staff, they are already addressing some of these issues. A new Corizon Health

Services Administrator (HSA) has been hired recently. The HSA is in the process of making changes

that are addressing deficiencies in the medical intake procedure. Prior to the release of this report, the

Jury learned that the SBSO staff are no longer conducting medical intake screenings. Corizon Registered

Nurses are currently conducting all prescreening medical intake procedures. This process should

continue and be documented on the medical process overview chart.

FINDINGS AND RECOMMENDATIONS Finding 1

The Santa Barbara County Sheriff is using an antiquated paper system for maintaining inmate medical

records at the Santa Barbara County Main Jail.

Recommendation 1

That the Santa Barbara County Sheriff implement a computerized medical record system for maintaining

inmate medical records at the Santa Barbara County Main Jail.

Finding 2

The Santa Barbara County Sheriff Staff, has not always followed procedures, policies, and protocols

pertaining to the intake process of arrestees.

Recommendation 2

That the Santa Barbara County Sheriff follow the established procedures, policies, and protocols

pertaining to the intake process of arrestees.


Finding 3 The Santa Barbara County Sheriff does not have adequate oversight methods in place for ensuring

Corizon Health staff are following their medical intake procedures at the Santa Barbara County Main Jail

before the inmate is transferred to custody officers for classification.

Recommendation 3

That the Santa Barbara County Sheriff update Appendices A and B and add two signature blocks, one for

medical clearance staff the other for the custody officer prior to classification at the Santa Barbara County

Main Jail. .

Finding 4

The Santa Barbara County Sheriff medical intake prescreening questionnaire is now being conducted by

Corizon Health registered nurses; however, the Medical Process Overview Chart does not reflect this.

Recommendation 4 That the Santa Barbara County Sheriff continue to use Corizon Health registered nurses to conduct all

medical intake screening of arrestees entering the Jail and include this provision in all future contracts

and in the Medical Process Overview Chart.

Finding 5 The Santa Barbara County Sheriff’s Custody Operations Policy and Procedures Manual regarding the

intake process needs revision.

Recommendation 5

That the Santa Barbara County Sheriff update the Custody Operations Policy and Procedures Manual to

reflect the new changes being implemented to the intake process.

Finding 6 The Santa Barbara County Sheriff staff has not always confirmed arrestees were medically cleared by

Corizon Health staff prior to classification and placement into the Jail population.

Recommendation 6

That the Santa Barbara County Sheriff initiate a procedure to ensure that all medical intake procedures

are properly completed prior to classification and that inmate classification not be allowed to occur

without verification of the completion of medical evaluation and clearance.

REQUEST FOR RESPONSE Pursuant to California Penal Code Section 933 and 933.05, the Santa Barbara County Grand Jury

requests each entity or individual named below to respond to the enumerated findings and

recommendations within the specified statutory time limit:

Santa Barbara County Sheriff 60 days

Findings 1, 2, 3, 4, 5, and 6

Recommendation 1, 2, 3, 4, 5, and 6


APPENDIX A Santa Barbara Sheriff’s Medical Pre Screening


APPENDIX B Intake and Receiving Screening CS1101


APPENDIX C MEDICAL PROCESS OVERVIEW


APPENDIX D CLINICAL OPIATE WITHDRAWAL SCALES (COWS)


APPENDIX E Receiving Screening Process

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